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Implement EMRs to Succeed in Health-Care Reform

Every day new medical devices, communication tools, vehicles, accessories and information technology (IT) solutions are brought to the EMS market. All are designed to make us work smarter or be safer.

At the annual EMS Today Conference & Exposition, hundreds of vendors convene to showcase the newest, best solutions. Some of these have the potential to revolutionize the delivery of prehospital care. How do you know whether to purchase these items?

Prior to health-care reform, we had to answer important questions. Will the technology make a difference in patient care or improve vehicle safety? Is the device modifiable based on specific needs or abilities? Will the tool work the same way in Alaska as in Texas? Does our budget allow us to purchase this technology, or is there a more efficient solution to achieve the same goal for a lower price?

In the face of health-care reform, however, we must ask even more questions. How will this technology advance our position in a reform environment where cost, access and quality are the primary drivers? Will the technology help us link patients to and within other health organizations? How will this technology directly improve outcomes for patients at the end of the care episode?

Reform & Technology
The electronic medical record (EMR) has been around for 20-plus years, but it didn’t start gaining popularity until about 10 years ago when marketers promised the tool would save millions of dollars. Today, EMRs are heralded more for patient safety than return on investment.

The reform legislation places greater emphasis on EMRs primarily because they’ll help authorized organizations across the care continuum communicate seamlessly. They also offer other benefits, such as enabling caregivers to have immediate access to updated protocols, alerting caregivers to potential medication interactions and providing crews with immediate access to a complete patient history.

Rarely does EMS have a record of previous care, allergies and medications, other than via verbal history provided at the scene. EMRs may present the first opportunity for medics to have a detailed and complete medical background in the field. There are many cases where having this wealth of information can be invaluable in treating complex cases for which the root of the problem isn’t immediately clear. For the patient, in-field EMR means a safer, more effective health-care experience.

True EMR implementation is complex. For EMS, it’s complicated further when you consider that many rural systems are run primarily by volunteer agencies that have limited financial resources. Municipalities and hospitals often prefer to invest in bricks and mortar rather than IT. The reality is, reform is moving us all to think in terms of clicks rather than bricks, and anyone who funds health care must be convinced of this fact.

Beyond the EMR
IT can help build efficiencies that will make you more successful under health-care reform. Exploring such concepts as the electronic intensive care unit (eICU), by which patients can have a wide range of conditions addressed by remotely located and electronically linked physicians during transport. This mimics the way we currently oversee patients via leads and central monitoring in an ICU, a system proven to improve patient outcomes.

Readily accessible and relatively inexpensive communication tools, such as the iPad or iPhone, can bring reference material and continuously updated protocols to medics and other caregivers. These same technologies can link physicians to EMS personnel in the field. For a relatively small investment, you can have a physician-level assessment anywhere Wi-Fi is available.

Of course, the majority of high-risk, low-yield situations don’t allow time for you to obtain a remote second opinion. Even so, IT can help you prepare for difficult situations using medical simulation. Simulation provides real benefits when practicing difficult skills, such as deliveries and intubations.

Even before health-care reform, EMS systems were feeling the pressure to invest in EMRs and other technologies. Reform has changed the game and advanced the timetable, but ultimately the issues and opportunities are the same. In the health-care industry, at the end of the day, the true test of any technology is demonstrating improved patient outcomes. If a technology can pass this test, then it’s probably a good investment and will likely be rewarded under health-care reform.

The days of filling out paper charts with only the patient’s name, a few check boxes and a couple of signatures are a thing of the past. The government has already allocated some grants to help hospital and physician groups with IT purchases, but EMS was in effect excluded from the original reform legislation. This presents you with an excellent opportunity to make connections and educate decision-makers about IT challenges and opportunities within EMS.

Lawmakers need to understand that you may be able to invest in technology or ambulances, but it’s unlikely you’ll be able to do both, and you need financial incentives and grant funds to comply with the intent of the reform legislation. Do your part to educate them soon. JEMS

This article originally appeared in October 2010 JEMS as “National Health-Care Update: Clicks, not bricks.”

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